By Dr Mohammad Manzoor
• Ulcerative Colitis is an ulceroinflammatory
disease affecting the colon, which is limited
the mucosa and submucosa, except
in the most severe cases.
• It begins in the rectum and extends
proximally in a continuous fashion
sometimes involving the entire colon
• More common in USA & Western countries.
The incidence has risen in recent decades.
More common among whites. Females are
affected slightly more. A peak incidence
between ages 20-25 years. Has a familial
• Rectum & Sigmoid --may involve entire colon.
• The lesions are continuous.
• inflammatory destruction of the mucosa with
macroscopic appearance of :
• Hyperemia, edema, and granularity with
friability and easy bleeding.
• With severe active disease:
• Extensive and broad based ulceration in the distal
• Toxic megacolon
Pseudopolyps are projecting masses of scar tissue
that develop from granulation tissue during the
healing phase in repeated cycle of ulceration
(especially in inflammatory bowel disease).
• A diffuse, predominantly mononuclear
inflammatory infiltrate in the lamina propria
and Crypt abscesses.
• Bloody mucoid diarrhea
• Cramps ( a painful & involuntary muscular contraction)
• Tenesmus (painful spasm of the anal sphincter along with the urgent desire to defecate
without the significant production of feces)
• Colicky lower abdominal pain
• Weight loss
Comparison of CD &UC
• Crohn disease and ulcerative colitis differ in
many respects, including the natural history of
the disease, pathological aspects, and in the
types of therapies and responses to
Comparisons of various factors in Crohn's disease and ulcerative colitis
Involves terminal ileum
Bile duct involvement?
Higher rate of Primary
Distribution of Disease
Patchy areas of
Continuous area of
Linear and serpiginous
Depth of inflammation
May be transmural, deep
Comparisons of various factors in Crohn's disease and UC
Can have granulomata
Crypt abscesses and
Surgical cure ?
Usually cured by
removal of colon,
following removal of
Higher risk for smokers Lower risk for smokers
Generally regarded as
Lower than ulcerative
Higher than Crohn's
Diffuse,mucosal Focal, trans&submucosal, mural, right
Lymphoid aggregate Rare
• Histopathologic and clinical overlap between
ulcerative colitis and Crohn disease is common, and
it is not possible to make a distinction in up to 10%
of patients with IBD. In such cases, termed
indeterminate colitis, the small bowel is not
involved, and the continuous pattern of colonic
disease typically would indicate ulcerative colitis.